Dexmedetomidine as an Adjuvant to Nerve Block for Cancer Surgery: A Systematic Review and Meta-Analysis

Background/Objectives: Our understanding of dexmedetomidine, as an adjuvant to nerve blocks in cancer surgery, is characterized by a current lack of compelling evidence, and it remains unknown whether the potential benefits of use outweigh the risks. The aim of the study was to evaluate the benefit and safety profiles of dexmedetomidine as an adjuvant to nerve blocks in cancer surgery. Methods: Systematic searches were conducted in MEDLINE, ScienceDirect, Cochrane Library, Springer, medRxiv, and Scopus up to 17 May 2024. Risk ratios (RR) for binary outcomes and standardized mean differences (SMDs) for continuous outcomes were quantified. Results: Twenty studies were identified. In breast cancer surgery, the use of dexmedetomidine reduced 24 h total morphine consumption (SMD = −1.99 [95% CI −3.01 to −0.98], p = 0.0001, I2 = 91%, random effects) and prolonged the requirement for morphine rescue analgesia (SMD = 2.98 [95% CI 0.01 to 5.95], p = 0.05, I2 = 98%, random effects). In abdominal cancer surgery, the dexmedetomidine group had lower total sufentanil consumption (SMD = −1.34 [95% CI −2.29 to −0.40], p = 0.005, I2 = 84%, random effects). Dexmedetomidine reduced the VAS score and decreased postoperative nausea and vomiting (PONV). No studies using dexmedetomidine reported serious adverse events. Conclusions: Using dexmedetomidine as an adjuvant to nerve blocks in cancer surgery could lower the VAS pain score and prolong the regional anesthesia duration, which would lead to a decrease in total opioid consumption and possibly contribute to fewer PONV events. Furthermore, the reports of no serious adverse events indicate its good safety profile

Systematic Review Hubungan Terapi Kortikosteroid Dengan Tinggi Badan Pada Sindrom Nefrotik Anak

Background: Treatment of nephrotic syndrome using corticosteroid especially prednisone, which belongs to a class of glucocorticoid. Glucocorticoids are proven to be able to inhibit the growth through several mechanisms. Objective: Analyze the correlation between corticosteroid therapy and height in childhood nephrotic syndrome. Methods: This is a systematic review. The databases used are PubMed, Science Direct, and Research Gate with the keywords "(corticosteroid OR prednisone OR prednisolone) AND (height) AND (nephrotic syndrome) AND (children)". Quality assessment was done by quality assessment tool for quantitative studies from EPHPP and by looking at the literature publisher's ranking in the Scimago Journal Rank. Results: From 1170 literatures, 21 full text papers were screened and three paper that met the inclusion criteria for final analysis. Assessment of journal quality obtained two literatures with strong results and one literature with moderate results. The results of z-scores on children's initial height from the three literatures were -0.76 ±1.96; 0±0.63; and -0.3±1.28. The results of z-scores for the child's final height were -0.89±2.05; -0.1±0.45; and -0.5±1.07. Two literatures suggest there is a correlation between corticosteroid therapy and height on childhood nephrotic syndrome and one literature didn’t find the correlation between them. Conclusion: The mean final height z-scores are -0.66±3.04 and height of SDNS (-0.33±0.87) and SRNS (-0.97±1.34) patients are lower than SSNS (-0.27±0.97) patients. There is a correlation between corticosteroid therapy and height on childhood nephrotic syndrome